This Month in Archives of General PsychiatryFREE

Is depression an adaptation, a pathological extreme of a defense, or an abnormal state unrelated to any adaptation? NesseArticle suggests that in unpropitious situations, low mood can be useful to prevent losses and reallocate effort. It may escalate to depression if an individual is unable to give up an unreachable goal. Global reductions in initiative and self-esteem may prevent prematurely abandoning an unsatisfactory but irreplaceable major life enterprise. This could explain why depression is prevalent in people who are trapped in failing relationships or other major life enterprises, and why depression often maintains itself in a vicious cycle.

It is not until midadolescence that a dramatic shift in depression rates marks the onset of the 2:1 female-to-male gender gap in unipolar depression. Cyranowski et alArticle offer a theoretical framework that may explain the timing of this phenomenon.

Birmaher et alArticle report on a 2-year follow-up of adolescents who participated in a randomized clinical psychotherapy trial for depression. Despite greater efficacy of cognitive therapy over family or supportive therapy for the acute treatment of depression, the rates of recovery (80%), recurrence (30%), and chronic depressive course (20%), were similar across the 3 treatments.

Many children go through a period of aggressive behavior that is serious enough to warrant a diagnosis of conduct disorder, but later adjust normally. Others persist in aggressive behavior for years and develop chronically antisocial lifestyles as adults. McBurnett et alArticle studied boys with problem behavior for 4 years and collected samples of their saliva at 2 time points. Low salivary cortisol levels at both time points were associated with early onset and persistence of aggression. Although the study could not determine causality, it suggests that one of the biological systems that responds to stress is altered in some children with persistent aggression.

Bartzokis et alArticle measured the amount of iron in brains of patients with Alzheimer disease (AD) and control subjects, using a novel noninvasive magnetic resonance imaging method that measures the iron stored in ferritin molecules. Patients with AD had higher iron levels in the basal ganglia than control subjects. Iron levels did not differ between the groups in frontal lobe white matter. Although the study cannot establish a direct causal relationship between increased iron levels and AD, iron is a known catalyst of damaging free radical reactions. Future research may elucidate the role of brain iron as a risk factor for AD.

Deficits in attention and cognition are common in individuals with schizophrenia, possibly due to an inability to filter out irrelevant sensory stimulation, leading to information overload. A brain response reflecting the ability to inhibit repeated stimulation, collected using the auditory dual-click P50 paradigm, has served as a measure of this filtering deficit in schizophrenia. Patterson et alArticle used a computerized procedure to evaluate temporal variability, and observed that fluctuations in the timing of the P50 brain response from trial-to-trial influence the extent of inhibition observed. Temporal variability may be a central feature underlying problems in attention and cognition in schizophrenia.

Alterations in the synaptic circuitry of the prefrontal cortex (PFC) are thought to contribute to cognitive dysfunction in schizophrenia. Glantz and LewisArticle found that the density of dendritic spines, markers of excitatory synapses, was selectively decreased on deep layer 3 pyramidal neurons in the PFC of schizophrenic subjects. In contrast, spine density did not significantly differ among normal controls, schizophrenic subjects, and psychiatric comparison subjects for other pyramidal neurons in the PFC or in primary visual cortex. These finding suggest that excitatory inputs to layer 3 of the PFC, which may include projections from the thalamus, are reduced in schizophrenia.

Hoehn-Saric et alArticle found that the seratonin reuptake inhibitor sertaline had greater efficacy than desipramine (primarily a norepinephrine reuptake inhibitor) on measures of depression and symptoms for patients with obsessive-compulsive disorder and concurrent major depressive disorder.

Perspectives on the direction of psychiatric research in the new millenium by Frank and KupferArticle, Akil and WatsonArticle, HymanArticle, and Coyle and SchwarczArticle are included.

Figures

Tables

References

Correspondence

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with
the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.

Indicate what change(s) you will implement in your practice, if any, based on this CME course.

Your quiz results:

The filled radio buttons indicate your responses. The preferred responses are highlighted

For CME Course:
A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes

Indicate what changes(s) you will implement in your practice, if any, based on this
CME course.

Instructions

Thank you for submitting a comment on this article. It will be reviewed by JAMA Psychiatry editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.

Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.

* = Required Field

Comment Author(s)* (if multiple authors, separate
names by comma)

Example: John Doe

Affiliation & Institution*

Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.

This feature is provided as a courtesy. By using it you agree that that you are requesting the material solely for personal, non-commercial use, and that it is subject to the AMA's Terms of Use. The information provided in order to email this article will not be shared, sold, traded, exchanged, or rented. Please refer to The JAMA Network's Privacy Policy for additional information.

Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.